Attached is the article for this assignment, the rubric, the assignment questions. The Last attachment is what i have written so far. Im not sure if is correct. I really need guidence on what to do to finish
Yoga for Military Service Personnel With PTSD: A Single Arm Study Jennifer M. Johnston Boston University Medical Center Takuya Minami University of Massachusetts Boston Deborah Greenwald and Chieh Li Northeastern University Kristen Reinhardt University of Oregon Sat Bir S. Khalsa Brigham and Women’s Hospital, Boston, Massachusetts This study evaluated the effects of yoga on posttraumatic stress disorder (PTSD) symptoms, resilience, and mindfulness in military personnel. Participants completing the yoga intervention were 12 current or former military personnel who met the Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition-Text Revision (DSM–IV–TR) diagnostic criteria for PTSD. Results were also benchmarked against other military intervention studies of PTSD using the Clinician Administered PTSD Scale (CAPS; Blake et al., 2000) as an outcome measure. Results of within-subject analyses supported the study’s primary hypothesis that yoga would reduce PTSD symptoms (d � 0.768; t � 2.822; p � .009) but did not support the hypothesis that yoga would significantly increase mindfulness (d � 0.392; t � �0.9500; p � .181) and resilience (d � 0.270; t � �1.220; p � .124) in this population. Benchmarking results indicated that, as compared with the aggregated treatment benchmark (d � 1.074) obtained from published clinical trials, the current study’s treatment effect (d � 0.768) was visibly lower, and compared with the waitlist control benchmark (d � 0.156), the treatment effect in the current study was visibly higher. Keywords: yoga, posttraumatic stress disorder, PTSD, military service personnel, complementary and integrative medicine Posttraumatic stress disorder (PTSD) is a mental health condi- tion that may result from experiencing traumatic events. PTSD, particularly in the military, is a focus of much research investiga- tion (e.g., Foa, Keane, Friedman, & Cohen, 2009) and military service men and women are particularly at risk for PTSD. For example, interpersonal violence, such as front-line combat, which many troops experience, is more highly correlated with PTSD than other, noninterpersonal types of trauma, such as natural disasters and motor vehicle accidents (Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition-Text Revision [DSM–IV–TR]; American Psychological Association, 2000), and military person- nel not involved in combat are also exposed to a variety of psychosocial and physical stressors and other military-specific situations to which the general population would not normally be exposed. Recent studies have evaluated the impact of yoga on PTSD symptoms in a civilian population, including a protocol of yogic breathing with exposure treatment, which reduced anxiety and depressive symptoms in survivors of the South-East Asia tsunami (Descilo et al., 2010). Two yoga studies (van der Kolk, 2006; van der Kolk et al., 2014) included women with PTSD. These studies found that the yoga interventions significantly improved PTSD re-experiencing and avoidance symptoms. Thus far, two studies (Mitchell et al., 2014; Staples, Hamilton, & Uddo, 2013) assessing yoga for PTSD symptoms have included military service personnel. Mitchell et al. (2014) conducted an RCT of 38 women, some of whom were military veterans, with full or subthreshold PTSD and found that both the yoga group and control group had significant reductions in re-experiencing and hyperarousal symptoms after a 12 session program. Staples et al. (2013) conducted a single-arm trial with military veterans with military-related PTSD and found that the 12 veterans who partic- ipated in the 12 session yoga intervention had a significant im- This article was published Online First May 25, 2015. Jennifer M. Johnston, Department of Psychiatry, Boston University Medical Center; Takuya Minami, Department of Counseling and School Psychology, University of Massachusetts Boston; Deborah Greenwald and Chieh Li, Department of Counseling and Applied Educational Psychology, Northeastern University; Kristen Reinhardt, Department of Psychology, University of Oregon; Sat Bir S. Khalsa, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts. This study was supported by US Department of Defense Awards W81XWH-08-2-0203 and W81XWH-10-1-1066 to S.K. at Brigham and Women’s Hospital from the Telemedicine & Advanced Technology Re- search Center (TATRC) of the US Army Medical Research and Material Command (USAMRMC) and by the Institute of Extraordinary Living of the Kripalu Center for Yoga and Health. Correspondence concerning this article should be addressed to Jennifer M. Johnston, Boston University School of Medicine–Psychiatry, 85 East Newton Street, Solomon Carter Fuller Building, Room 918, Boston, MA 02115. E-mail: jennifer.m.johnston@gmail.com T hi s do cu m en t is co py ri gh te d by th e A m er ic an Ps yc ho lo gi ca l A ss oc ia tio n or on e of its al lie d pu bl is he rs . T hi s ar tic le is in te nd ed so le ly fo r th e pe rs on al us e of th e in di vi du al us er an d is no t to be di ss em in at ed br oa dl y. Psychological Trauma: Theory, Research, Practice, and Policy © 2015 American Psychological Association 2015, Vol. 7, No. 6, 555–562 1942-9681/15/$12.00 http://dx.doi.org/10.1037/tra0000051 555 mailto:jennifer.m.johnston@gmail.com http://dx.doi.org/10.1037/tra0000051 provement in PTSD hyperarousal symptoms and overall sleep quality as well as a reduction in sleep-related daytime dysfunction. This empirical evaluation of contemplative practices such as yoga to manage PTSD symptoms for people with PTSD is under- standable given the evidence base for yoga in other populations, and also because PTSD is a psychophysiological condition (Telles, Singh, & Balkrishna, 2012) warranting interventions that address both the physical and psychological symptoms of PTSD. Yoga is an integrative system of practices geared toward self-understanding, self-regulation, and psychological and physical well-being (Garfinkel & Schumacher, 2000; Khalsa, 2004). Yoga has also been shown to increase an inhibitory neurotransmitter gamma amino butyric acid (GABA; Streeter et al., 2007, 2010), which is relevant to people with PTSD as this group of people has been shown to be low in GABA system activity and to experience reduction in anxiety and depressive symptoms when prescribed pharmacological agents which increase activity of the GABA system (Streeter, Gerbarg, Saper, Ciraulo, & Brown, 2012). Yogic practices include compo- nents that may reduce, interrupt, or reframe re-experiencing, stress, arousal, and avoidance symptoms of PTSD by eliciting the relax- ation response (Benson, 1975), which counterbalances the “fight or flight response” by down regulating the stress system and increasing present-moment nonjudgmental awareness and accep- tance, which is often challenging for people with PTSD. The mindfulness and psychophysiological stress reduction skills in a yoga practice provide the practitioner with tools to manage triggers and symptoms with acceptance rather than avoidance. This may reduce reactivity and ensuing learned avoidance behaviors, and may help counteract trauma-relevant avoidance in these individu- als. Yoga contains within its system not only mental practices but also physical poses (asanas) that have been shown to reduce musculoskeletal and mental tension, increase cognitive attentive- ness or mind-body awareness and mindfulness, and improve phys- ical flexibility and strength (Netz & Lidor, 2003; Serber, 2000). Yogic breathing exercises (pranayama) modify respiratory fre- quency and tidal volume, which elicits psychological and physio- logical changes (Brown & Gerbarg, 2009; Pal, Velkumary, & Madanmohan, 2004). Kulkarni and Bera (2009) propose that mod- ulation of breath, via its impact on the central nervous system (CNS), plays a critical role in maintaining balance or allostasis and reducing cognitive and emotional reactivity. Thus, Kulkarni and Bera (2009) propose that modulation of breath results in psycho- logical and physiological change, including increasing mindful- ness and reducing stress. Mindfulness, or present-moment nonjudgmental awareness, is an integral dimension in yoga practice, and yoga has been shown to increase mindfulness (Shelov, Suchday, & Friedberg, 2009). It has been negatively correlated with physical and psychiatric symp- toms and positively correlated with well-being; Carmody and Baer (2008) indicate that various psychological and physical complaints have been reduced through a mindfulness practice, as have previ- ous studies (Baer, 2003; Kabat-Zinn, 2003). Resilience is an individual’s ability to adjust or cope with change or misfortune (Rutter, 1987). Yoga has been seen to improve resilience in other populations by reducing oxidative stress (Martarelli & Pom- pei, 2009) and reducing and preventing inflammation (Olivo, 2009), as well as by reducing anxiety (Subramanya & Telles, 2009), perceived stress, and depressive symptoms (Simard & Henry, 2006), and by increasing meaning and promoting dynamic coping (Chan, Chan, & Ng, 2009). Resilience may be critical in creating an optimal healing environment (OHE; Osuch & Engel, 2004), which includes a multicomponent (i.e., social, psychological, spir- itual, physical, and behavioral) approach (Jonas & Chez, 2004) toward optimizing healing. Based on their research, Osuch and Engel explicitly recommend mind/body practices as a means to heal trauma. Frueh et al. (2007) noted the necessity for the U.S. Department of Veterans Affairs to update policies to include empirically supported concepts of resilience. The theoretical focus of the yoga intervention in the current protocol was to help participants increase awareness, release chronic tension and decrease maladaptive automatic reactions, develop a nonjudgmental attitude, and induce a state of relaxation to optimally manage current symptoms and metabolize previous experiences. The current study extends prior research and is unique in that it uses a manualized Kripalu yoga intervention to explore whether the physical, cognitive, and psychological practices used in the intervention are an effective means of decreasing PTSD symptoms as assessed by the CAPS, and evaluates whether yoga may increase mindfulness as demonstrated by the Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006), and resil- ience, as measured by the Resilience Scale (RS; Wagnild, 2009; Wagnild & Young, 1990), in military service men and women. Also unique is that the data for the participants in the study were benchmarked against other interventions used to treat the military men and women with PTSD. This enabled the authors to contex- tualize the results of the current yoga intervention with other PTSD treatments used for the military population given the study’s lack of control group. Method After all protocol materials were approved by the Institutional Review Boards (IRB) from the Department of Defense Telemedi- cine and Advanced Technology Research Center, the Brigham and Women’s Hospital, and Northeastern University, recruitment of participants took place via posting flyers in the local area as well as advertisements in the newspaper and on trains through the Massachusetts Bay Transportation Authority. Potential partici- pants underwent a telephone screening to preliminarily assess eligibility, and, when deemed potentially eligible, came in for an in-person interview. During this meeting, informed consent was obtained and an interview was then performed to ensure inclusion criteria were met. After screening into the study, participants underwent a baseline CAPS assessment and then completed base- line questionnaires before undertaking the 10-week yoga interven- tion. At the final yoga class, they completed